Community Reinforcement Approach and Family Training (CRAFT)

The aim of Community Reinforcement Approach and Family Training (CRAFT) is to offer addiction-affected family members (AFMs) support and strategies to increase the likelihood that a close one (identified person; IP) reduces alcohol or drug use or gambling and/or seeks treatment, as well as increasing psychological health and quality of life for the AFM. CRAFT applies treatment traditions from Motivational Interviewing and Cognitive Behavioral Therapy. CRAFT is structured but may be adjusted to the needs of the AFM. During sessions themes are introduced together with tools for behavior change that participants practice throughout the intervention. Central CRAFT themes are building up hope for change, improving the mental health and quality of life of the AFM, insight in what drives addictive behavior, prevention of violent behavior, functional analysis of how behaviors are facilitated by context and expectations, positive communication, making use of positive reinforcement, allowing natural negative consequences to occur, and help to initiate treatment for the IP. The efficacy of CRAFT has been investigated, with most studies performed in the United States. CRAFT has been studied in various formats (individual, group, combination of individual and group, self-help, and internet-delivered) and is efficacious in engaging IPs with alcohol or substance use disorder in treatment, compared to active and non-active comparators. Although CRAFT is irrefutably beneficial for many AFMs and IPs, issues regarding the scientific evidence, content, and administration of CRAFT have been raised. For example, the scientific quality of many CRAFT studies has been deemed to be generally low. Also, a large variability in treatment engagement rates for IPs points to the importance of taking contextual factors into account when interpreting the outcomes of CRAFT studies.